Dental Coverage

[riss29]

Dental Coverage For Class A Reservist:
Will this cover braces?

 

[Nfld Sapper]

1. Eligible services
A detailed description of eligible services is provided in Annex B. Below is a summary of the major features of the Plan's eligible services, by category.

Benefits Reimbursed at 90%
Diagnostic:
(excluding services related to major prosthodontic)
examinations, x-rays, laboratory examinations
Preventive:
dental cleaning and polishing, topical application of fluoride, space maintainers
Minor Restorative:
amalgam, silicate, acrylic or composite
Endodontics:
root canal therapy
Periodontics: treatment of gums
Minor Prosthodontic: (services for removable dentures):
repairs and adjustments, relining and rebasing
Surgery:
extractions of teeth, other surgical procedures
Adjunctive Services:
emergency services not otherwise specified, anaesthesia



Benefits Reimbursed at 50%
Major Restorative:
gold and porcelain restorations (inlays), crowns
Major Prosthodontic
complete dentures, partial dentures, fixed bridges (abutments, pontics), repairs of fixed dentures (bridges)
Orthodontic
(applies to a covered spouse or a covered child under 21 years of age or under 25, if in full-time attendance at school or university).
Surgical services, observation and adjustments, fixed appliances, removable appliances

 

[PMedMoe]

I'm not even sure that Class A Reservists are entitled to Dental care beyond their working hours.

According to QR&O 35.04:

(ii) Class "A" Reserve Service performing duty or training other than at a local headquarters, local parade, local demonstration or local exercise; or
   
(b) is entitled, where the member suffers any injury to the teeth attributable to the performance of duty, to the treatment that is necessary to restore a state of dental fitness comparable to that which existed prior to the injury, if such injury is not attributable to the member's own misconduct or imprudence.

 

[Nfld Sapper]

Class A are entitled if they decide to participate. Cost is $25/year.

I know because I am a member of the plan.

 

[dapaterson]

Talking at cross-purposes.

There is a dental insurance plan for class A reservists - that's what Nfld Sapper is talking about.

There isn't access to CF dentists, though - that's what PMedMoe is talking about.

 

[PMedMoe]

Well, there you go.  We covered it from both angles. 

Just wanted to make sure the member was properly informed.  "Coverage" has many definitions. 
$25/year for dental insurance?  Good plan!

 

[kratz]

For more information on the DGCB - Reserve Dental Care Plan, here is the link. Remember online information may not be current with up to the minute policy changes.

 

[Rheostatic]

Orthodontic
(applies to a covered spouse or a covered child under 21 years of age or under 25, if in full-time attendance at school or university).

Does this mean that orthodontic treatments are not available to the plan member?

 

[Snakedoc]

Does this mean that orthodontic treatments are not available to the plan member?

It looks to me that orthodontic treatments are available to the plan member at 50% coverage and only to the covered spouse or child based on the set out conditions.

$25/year for this type of coverage is definitely a great deal!

 

[Belaj]

Dental Coverage For Class A Reservist:
Will this cover braces?

Yes, I can personally confirm that. Great-West will cover 50%, max 1700$ (?) per year, lifetime max of 2500$. Note that the class A coverage has a few requirements (such as time in). Contact your Orderly Room, they'll have the details.

 

[justmyalias]

Hello,

I did a search in here but couldn't find anything pertaining to this subject so if there is one, feel free to merge and I'll pick up any nuggets in there.
==========>>>
I am interested to know what is available for both the mbr & dependants, as a "Class A", or a "B <180"

AFAIK, whenever you're on duty and something happens, the mbr is always covered correct, and tmt is done at the Mil facility?

This is more for when you're on "Class A", or a "B <180" contract, and if Class A, when you're not 'on duty'.

MEDICAL COVERAGE ENTITLEMENT:
(I'm hoping entitlements are the same, whether you're on a 180+ Class B or Less, it's just the difference of employee-paid rate vs self-paid?  Correct?)

Dependants:
PSHCP is available as self-paid option ($90'ish?) for Dependants, confirm?  Does this then cover the mbr as well?  Or do we use our Blue Cross card?  If not, what do we use?

From the PSHCP Booklet:

(b)

Class A and Class B Reservists are eligible to join the Plan on the following dates:

(i)

if engaged for a period of less than 180 days, the date of eligibility is the
date taken on strength;

For Class A, What is the date taken on strength when there's no contract?  Would it be just the first day you were no longer on your Class B?  So say your 365 Class B ended Jan 1st, then date taken on strength would be Jan 2nd?

Mbr:
Do we go to any civvy clinic and submit claims just as we do for dependants?  Or thru PositiveEnrollment if you have that set up?  Do we have coverage under PSHCP or BlueCross or...?

DENTAL COVERAGE:
I haven't found any suggestion that there is a self-paid avenue.  I remember reading awhile ago that GWL is activated & available 24/7 for Reservists & Dependants so long as they're, Reservists.  A/B> OR <180, C.  That's for Dependants, but I don't know about the mbr.  Curiously, when you log-in it has always shown my name with entitlements for all the years, but of course I've always gone through the Dent U, so never claimed anything through there.  I'm assuming it's just set up permanently, for whenever I wouldn't be on a B <180 that I can claim benefits just the same?

Does anybody know if the benefits would be any different than for dependants, that is for the mbr?  Should be identical no?

So, for the mbr, does one just submit as for dependants, the receipts from any civvy Dentist?  Take to the OR, have them stamp it and fire off?

If it turns out there is no PSHCP nor Dental while Class A or B<180, does anybody have any recommendations for alternative Med/Dent providers?

 

[my72jeep]

A class A can buy into the PSHCP but it has no dental. cost is any where from$124-$134 a month. covers 80%. all you need to do is apply. with that when ever you are on duty the CF pays that part and you will get a re payment for the days worked in Feb. the take on dat is 3 months from App date.

 

[Brasidas]

DENTAL COVERAGE:
I haven't found any suggestion that there is a self-paid avenue.  I remember reading awhile ago that GWL is activated & available 24/7 for Reservists & Dependants so long as they're, Reservists.  A/B> OR <180, C.  That's for Dependants, but I don't know about the mbr.  Curiously, when you log-in it has always shown my name with entitlements for all the years, but of course I've always gone through the Dent U, so never claimed anything through there.  I'm assuming it's just set up permanently, for whenever I wouldn't be on a B <180 that I can claim benefits just the same?
If it turns out there is no PSHCP nor Dental while Class A or B<180, does anybody have any recommendations for alternative Med/Dent providers?

Class A reserve has 90% coverage; there's no need to buy into any program to get it.

I had a routine dental visit turn into a $1200 root canal, and I only had to cough up $120. The dental office will come up with a claim form, which you bring in to your OR for a stamp or scribbling in of info.

If your clerk doesn't have the info, politely insist that they inquire on your behalf.

 

[justmyalias]

A class A can buy into the PSHCP ...cost is any where from$124-$134 a month. covers 80%. all you need to do is apply...

That is for the fam AND mbr?  or just fam?  How does BlueCross come into play for the mbr?  Does it?

HOW do I apply?  I'm having a hard time getting that done.  I am walking on egg shells, getting close to the two month mark, but the person I'm corresponding with is inundated with other stuff already, on a deadline,  and has told me to ask again in a month!??  I don't want to go over anybody's head, but this is something that could potentially adversely affect my family's expenses, I've already been patiently trying to get an answer for a week now.

Class A reserve has 90% coverage; there's no need to buy into any program to get it....

Can you just confirm pls., how recent was this?  Good!  So it seems like vis-a-vis GWL & Dental, we're good to go, mbr & dependants!

Thank you!

 

[ajp]

90 Was accurate when I was PRes.  Your OR should be able to confirm.

 

[my72jeep]

That is for the fam AND mbr?  or just fam?  How does BlueCross come into play for the mbr?  Does it?

HOW do I apply?  I'm having a hard time getting that done.  I am walking on egg shells, getting close to the two month mark, but the person I'm corresponding with is inundated with other stuff already, on a deadline,  and has told me to ask again in a month!??  I don't want to go over anybody's head, but this is something that could potentially adversely affect my familys expenses, I've already been patiently trying to get an answer for a week now.
Can you just confirm pls., how recent was this?  Good!  So it seems like vis-a-vis GWL & Dental, we're good to go, mbr & dependants!

Thank you!

I pay $125 a month for a family of 3 info is up to date as I gust bought into it as of Jan 2012. http://www.pshcp.ca/english/forms/eeapplication.pdf
fill that out take it to your OR they fill out there part then you send it to PSHCP and it starts rolling. you need to send in 3 month in advance with the app.

 

[justmyalias]

I have that form actually, wondering if there's an SOU as well or just this?

^, that covers Dependants of course, but I'm wondering about the mbr as well?  Who or what covers the mbr for MED benefits?

That is the self-paid rate? Lvl 1/2/3?

I was a full-time B>180+++ for nearly a decade now, first time not full-time, so would my application still be a reinstatement (Top of the form)?  That's what I always did when I started a new B

Hmmm, Question 7, I never noticed says 'applicant only'?  I never realized that.  Always ticked 'with dependants'.  Would one tick off both then?

WOW...the last time I looked, the LVL 3 was $94'ish.  Have you looked around to see if there's a cheaper company out there?

 

[my72jeep]

call 1800 267 6542 that is the CF PSHCP Office and ask away.

 

[justmyalias]

You said,

I pay $125 for a family of 3...

I'm asking if this is the self-paid rate, and whether it is covering you or not, you didn't specify if the 3 includes you (the mbr) or not.  Not sure how PSHCP would answer those questions for you ?

I appreciate the link anyway.

 

[Brasidas]

That is for the fam AND mbr?  or just fam?  How does BlueCross come into play for the mbr?  Does it?

Just the member, family are on their own for class A. I don't know anything about BlueCross. I've done a combo of CF and employer insurance to cover it 100% (the employer insurance is the one that has to take the secondary role, and they have to be setup to do it).

HOW do I apply?  I'm having a hard time getting that done. 

Get a claim form from the dental office. Get the form to the OR currently responsible for you; get it stamped, and the OR should be able to mail it off for you.

I am walking on egg shells, getting close to the two month mark, but the person I'm corresponding with is inundated with other stuff already, on a deadline,  and has told me to ask again in a month!??  I don't want to go over anybody's head, but this is something that could potentially adversely affect my family's expenses, I've already been patiently trying to get an answer for a week now.

What is your situation vis a vis your military service? You're class A with regular parade nights? Or you're with some provincial brigade battleschool on your recruit course?

If it's the latter, talk to your instructors. They may know a clerk local to you who is familiar with the dental insurance process. It'll still probably have to go to your OR to file it, but this other hypothetical clerk can save your clerk a lot of the research. Some clerks still aren't familiar with it, though I've been using these claims for five years myself.

If you're just a regular parade guy, use your chain of command. Unofficially, at least at first, let them know you're feeling a pinch and that you need to get this dental claim sorted out sooner rather than later.

Worst case, if you really can't get something moving on this, I've got family who're ex-CF dental and know the process; I could get some help on that side. But my unit has zero clerks right now, and you want action on the clerk side.

Can you just confirm pls., how recent was this?  Good!  So it seems like vis-a-vis GWL & Dental, we're good to go, mbr & dependants!

Thank you!

My last dental claim was august 2011. This is still in place.